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General NPI Number Information
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NPI Number | 1699184291
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Entity Type | Individual
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Provider Name | LAUREN NELLAMATTATHIL DPT
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 3420 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1195
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Country | US
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Telephone | 773-360-7287
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Fax | 773-570-4843
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Provider Business Mailing Address
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Address Line | 2440 M ST NW STE 316
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City | WASHINGTON
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State | DC
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Zip | 20037-1449
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Country | US
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Telephone | 202-659-2673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.022172
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License Number State | IL
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